Asthma morbidity and mortality in poor, urban populations continues to be unacceptably high. Health scientists have no understanding of the reasons behind this phenomenon. Recently, we and others have suggested that allergic sensitization to cockroaches constitutes an important predictor of asthma morbidity in low income patients. If this is true, measures against cockroach infestation should become central in environmental policy planning with respect to urban housing. The main purpose of this project is to provide additional evidence supporting the concept that cockroach allergy has a causal relationship to asthma and to asthma severity and to begin examining proactive methods to combat this problem. Our multi- disciplinary team which covers the fields of clinical investigation, medical anthropology, respiratory epidemiology and medical entomology, has built a collaboration with the Housing Authority of Baltimore City, based on which we propose to perform a study involving the current residents of public housing that are to be relocated to new dwellings as part of an extensive plan to replace distressed complexes with new communities. After surveying entire populations of public housing complexes, we will identify residents with asthma and will fully characterize them with respect to atopic status and asthma severity. In addition, we will perform extensive evaluation of their original dwellings with respect to cockroach infestation and antigen levels. Using a case-control approach, we will assess whether cockroach exposure is a risk factor for asthma. Asthma morbidity and cockroach exposure will be then monitored longitudinally, in all asthmatics, while they are relocated into new homes. It is our hypothesis that the individuals with cockroach allergy who will be relocated to cockroach-free environments will experience significant improvement in their airway disease. Asthmatics without cockroach sensitivity will serve as negative controls. In a second cohort from the public housing population, we will test the effectiveness of a pro-active, early educational/behavioral modification program, combined with precision-targeted early mitigation, to avoid infestation of the new, cockroach-free homes. In conjunction with the above projects, we propose to develop and validate a new methodology for monitoring cockroach exposure, using multiple site dust sampling and spatial analysis techniques. This project can provide answers to crucial questions regarding the role of cockroach exposure in asthma and can impact the health of urban US populations who have disproportionally suffered from the morbidity and mortality of this disease.